Head Trauma in the Cat: 2. Assessment and Management of Traumatic Brain Injury

2011 ◽  
Vol 13 (11) ◽  
pp. 815-823 ◽  
Author(s):  
Laurent Garosi ◽  
Sophie Adamantos
Keyword(s):  
Traumatic Brain Injury ◽  
General Practice ◽  
Brain Injury ◽  
Head Trauma ◽  
Brain Injuries ◽  
Experimental Studies ◽  
Clinical Signs ◽  
Evidence Base ◽  
Neurological Deficits ◽  
Current Evidence

Practical relevance Feline trauma patients are commonly seen in general practice and frequently have sustained some degree of brain injury. Clinical challenges Cats with traumatic brain injuries may have a variety of clinical signs, ranging from minor neurological deficits to life-threatening neurological impairment. Appropriate management depends on prompt and accurate patient assessment, and an understanding of the pathophysiology of brain injury. The most important consideration in managing these patients is maintenance of cerebral perfusion and oxygenation. For cats with severe head injury requiring decompressive surgery, early intervention is critical. Evidence base There is a limited clinical evidence base to support the treatment of traumatic brain injury in cats, despite its relative frequency in general practice. Appropriate therapy is, therefore, controversial in veterinary medicine and mostly based on experimental studies or human head trauma studies. This review, which sets out to describe the specific approach to diagnosis and management of traumatic brain injury in cats, draws on the current evidence, as far as it exists, as well as the authors' clinical experience.

scholarly journals Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children

2020 ◽  
Author(s):  
Caroline Sönnerqvist ◽  
Ole Brus ◽  
Magnus Olivecrona
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Negative Predictive Value ◽  
Head Trauma ◽  
Predictive Value ◽  
Brain Injuries ◽  
Head Injuries ◽  
Traumatic Brain Injuries ◽  
Predictive Values ◽  
Initial Management

Abstract Background Head trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines. Methods We applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: “Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study” by Kuppermann et al. (Lancet 374(9696):1160–1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted. Results We analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group. Conclusion Children with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.

scholarly journals Lack of mitochondrial ferritin aggravated neurological deficits via enhancing oxidative stress in a traumatic brain injury murine model

2017 ◽  
Vol 37 (6) ◽  
Author(s):  
Ligang Wang ◽  
Libo Wang ◽  
Zhibo Dai ◽  
Pei Wu ◽  
Huaizhang Shi ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Knockout Mice ◽  
Brain Injuries ◽  
Brain Infarction ◽  
Neurological Deficits ◽  
Important Correlation ◽  
The Brain ◽  
And Oxidative Stress

Oxidative stress has been strongly implicated in the pathogenesis of traumatic brain injury (TBI). Mitochondrial ferritin (Ftmt) is reported to be closely related to oxidative stress. However, whether Ftmt is involved in TBI-induced oxidative stress and neurological deficits remains unknown. In the present study, the controlled cortical impact model was established in wild-type and Ftmt knockout mice as a TBI model. The Ftmt expression, oxidative stress, neurological deficits, and brain injury were measured. We found that Ftmt expression was gradually decreased from 3 to 14 days post-TBI, while oxidative stress was gradually increased, as evidenced by reduced GSH and superoxide dismutase levels and elevated malondialdehyde and nitric oxide levels. Interestingly, the extent of reduced Ftmt expression in the brain was linearly correlated with oxidative stress. Knockout of Ftmt significantly exacerbated TBI-induced oxidative stress, intracerebral hemorrhage, brain infarction, edema, neurological severity score, memory impairment, and neurological deficits. However, all these effects in Ftmt knockout mice were markedly mitigated by pharmacological inhibition of oxidative stress using an antioxidant, N-acetylcysteine. Taken together, these results reveal an important correlation between Ftmt and oxidative stress after TBI. Ftmt deficiency aggravates TBI-induced brain injuries and neurological deficits, which at least partially through increasing oxidative stress levels. Our data suggest that Ftmt may be a promising molecular target for the treatment of TBI.

scholarly journals Mannitol cannot reduce the mortality on acute severe traumatic brain injury (TBI) patients: a meta–analyses and systematic review

2015 ◽  
Vol 3 ◽  
pp. 1-8 ◽  
Author(s):  
Kai Wang ◽  
Mingwei Sun ◽  
Hua Jiang ◽  
Xiao-ping Cao ◽  
Jun Zeng
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Brain Injuries ◽  
Meta Analysis ◽  
Outcome Data ◽  
Control Treatment ◽  
Current Evidence ◽  
Cochrane Library

Abstract Background We aimed to systematically review the efficacy of mannitol (MTL) on patients with acute severe traumatic brain injury (TBI). Methods Databases such as PubMed (US National Library of Medicine), CENTRAL (The Cochrane Library 2014, Issue 3), ISI (Web of Science: Science Citation Index Expanded), Chinese Biomedicine Database (CBM), and China Knowledge Resource Integrated Database (CNKI) have been searched for relevant studies published between 1 January 2003 and 1 October 2014. We have established inclusion and exclusion criteria to identify RCTs, which were suitable to be enrolled in the systematic review. The comparison group could be hypertonic saline (HS), hydroxyethyl starch, or others. The quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 and modified Jadad score scale. The major outcome was mortality, followed by the secondary outcomes such as neurological outcome, days on intensive care unit (ICU), and ventilator day. In addition, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and mean arterial pressure (MAP) were used as the surrogate endpoints. Data synthesis and meta-analysis was conducted by using R (version 3.7-0.). Results When 176 potential relevant literatures and abstracts have been screened, four RCTs met all the inclusion criteria and were enrolled for the meta-analysis. Amongst all the enrolled studies, two trials have provided the primary outcome data. There was no heterogeneity between two studies (I2 = 0 %) and a fixed model was used for meta-analysis (n = 53), pooled result indicated that the mortality was similar in mannitol intervention and control treatment, OR = 0.80, 95 % CI [0.27, 2.37], P = 0.38. We found that both mannitol and HS were efficient in decreasing the ICP. Furthermore, the effect of the HS on the ICP appeared to be more effective in the patients with diffuse brain injuries than mannitol did. Conclusions As a conclusion, the mannitol therapy cannot reduce the mortality risk of acute severe traumatic brain injury. Current evidence does not support the mannitol as an effective treatment of acute severe traumatic brain injury. The well-designed randomized controlled trials are in urgent need to demonstrate the adoption of mannitol to acute severe traumatic brain injury.

An Overview of the Attention Improvement Management (AIM) Program With Outcomes for Three Pilot Participants

2012 ◽  
Vol 22 (3) ◽  
pp. 90-105 ◽  
Author(s):  
Jaime Lee ◽  
Beth Harn ◽  
McKay Moore Sohlberg ◽  
Shari L. Wade
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Injuries ◽  
Strategy Instruction ◽  
Daily Practice ◽  
Evidence Base ◽  
Outcome Data ◽  
Social Settings ◽  
Program Components ◽  
Pediatric Tbi

Direct attention training (DAT) and metacognitive strategy instruction have been employed to treat the cognitive deficits associated with traumatic brain injury (TBI) in children and are supported by an emerging evidence base (e.g., Butler et al., 2008; Galbiati et al., 2009; Luton, Reed-Knight, Loiselle, O’Toole, & Blount, 2011; van’t Hooft et al., 2007). The importance of treatment intensity is well established for DAT (Sohlberg et al., 2003), yet restrictions in the delivery and funding of rehabilitation services, the availability of well-trained interventionists, and access by geographic locale remain critical barriers to the provision of intensive services. Computer-delivered treatments that incorporate a home practice component address the gulf between the intensive, daily practice suggested by the efficacy research and these clinical delivery constraints. The purpose of this paper is to (a) review the literature evaluating the integration of DAT and metacognitive facilitation to treat children and adolescents with traumatic brain injury (TBI); (b) present the rationale and description of a computerized program, Attention Improvement Management (AIM); (c) detail the program components; and (d) present outcome data from three pilot participants who completed the intervention. A specific and growing subset of children with TBI have attention impairments following mild brain injuries or concussions (Schatz & Scolaro Moser, 2011) and served as the pilot participants in this study. Pilot participants demonstrated clinically meaningful improvements on attention outcome measures and generalization of the metacognitive strategies trained within the program to contexts outside of therapy, including both academic and social settings. Though initial results are promising, further research is needed to evaluate the efficacy of the AIM intervention to treat the attention and executive function impairments associated with pediatric TBI.

Abstract W P260: Role of the Prostaglandin E2 EP1 Receptor in Traumatic Brain Injury

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Alexander V Glushakov ◽  
Jawad A Fazal ◽  
Shuh Narumiya ◽  
Sylvain Dore
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Young Adult ◽  
Brain Injuries ◽  
Neurological Deficits ◽  
Cortical Lesions ◽  
Brain Pathology ◽  
Adult Mice ◽  
Ep1 Receptor

Introduction: Brain injuries promote upregulation of so-called proinflammatory prostaglandin E2 leading to overactivation of a class of its cognate G-protein coupled receptors, notably EP1, which is considered as a promising target for treatment of ischemic stroke and, possibly, other neurological disorders involving excitotoxicity. However, our recent data suggest that of EP1 receptor in intracerebral hemorrhage may play a protective role. The goal of this study was to investigate a translational potential of EP1 receptor for treatment of traumatic brain injury (TBI). Methods: The acute brain injury was induced using controlled cortical impact (CCI) in wildtype (WT) and genetic EP1 receptor knockout mice (EP1-/-). Neurological deficit scores (NDS) and anatomical brain pathology were accessed at 48h after injury. Results: CCI resulted in significant cortical lesions, localized hippocampal edema and neurological deficits compared to animals from sham group underwent craniotomy only. The NDS after CCI were significantly higher in older mice (7-11mo) compared to young adult animals (2-4mo) in both WT and EP1-/- groups. Treatment with a selective antagonist SC-51089 with repeated doses of 20-100μg/kg after CCI had no significant effects on cortical lesions, hippocampal edema and NDS in young adult mice of both WT and EP1-/- genotypes. Post-treatment with 17-pt-PGE2 (300μg/kg) had no significant effects on anatomical brain pathology in young adult mice, but improved NDS at 24h in WT but not in EP1-/- mice. Immunohistochemistry revealed significant increases in GFAP and Iba1 immunoreactivity in selected brain regions surrounding injury suggesting astrogliosis and microglia activation. EP1 receptor knockout had no effects on GFAP and Iba1 expression in young adult mice, whereas lead to a significant attenuation of GFAP immunoreactivity in older mice. Conclusions: This study provides, for the first time, a clarification on the role of EP1 receptor in a preclinical model of contusive TBI. The results suggest that EP1 receptor might be involved in complex pathways differentially associated with neurological deficits. In addition, this study provides further clarification on clinical use of EP1 receptor ligands for treatment of acute brain injuries.

scholarly journals Traumatic Brain Injury in Sports: A Review

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Christopher S. Sahler ◽  
Brian D. Greenwald
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Cognitive Impairment ◽  
Brain Injury ◽  
Head Trauma ◽  
Brain Injuries ◽  
Cognitive Impairments ◽  
The United States ◽  
Neurological Dysfunction

Traumatic brain injury (TBI) is a clinical diagnosis of neurological dysfunction following head trauma, typically presenting with acute symptoms of some degree of cognitive impairment. There are an estimated 1.7 to 3.8 million TBIs each year in the United States, approximately 10 percent of which are due to sports and recreational activities. Most brain injuries are self-limited with symptom resolution within one week, however, a growing amount of data is now establishing significant sequelae from even minor impacts such as headaches, prolonged cognitive impairments, or even death. Appropriate diagnosis and treatment according to standardized guidelines are crucial when treating athletes who may be subjected to future head trauma, possibly increasing their likelihood of long-term impairments.

scholarly journals Antipituitary antibodies after traumatic brain injury: is head trauma-induced pituitary dysfunction associated with autoimmunity?

2008 ◽  
Vol 159 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Fatih Tanriverdi ◽  
Annamaria De Bellis ◽  
Antonio Bizzarro ◽  
Antonio Agostino Sinisi ◽  
Giuseppe Bellastella ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Trauma ◽  
Animal Studies ◽  
Experimental Studies ◽  
Public Health Problem ◽  
Preliminary Evidence ◽  
Antipituitary Antibodies ◽  
Pituitary Dysfunction ◽  
Normal Controls

ObjectiveTraumatic brain injury (TBI) is a devastating public health problem that may result in hypopituitarism. However, the mechanisms responsible for hypothalamic–pituitary dysfunction due to TBI are still unclear. Although the antibodies against neurons have been demonstrated in injured animal studies, investigations regarding the occurrence of antipituitary antibodies (APAs) in patients with TBI are lacking in the literature. In order to investigate whether autoimmune mechanisms could play a role in the pituitary dysfunction after TBI, we have planned this study aimed at investigating the presence of APA at the third year of TBI and association between the TBI-induced hypopituitarism and APA.Patients and designTwenty-nine (25 males and 4 females; age 36.5±2.3 years) patients who had completed a 3-year follow-up after TBI were included in the present study. APA and pituitary function were evaluated in all the patients 3 years after TBI; moreover, APAs were tested also in sera of 60 age-/sex-matched normal controls. The APAs were investigated by an indirect immunofluorescence method.ResultsAPAs were detected in 13 out of the 29 TBI patients (44.8%), but in none of the normal controls. Pituitary dysfunction development ratio was significantly higher in APA-positive patients (46.2%) when compared with APA-negative ones (12.5%; P=0.04). There was a significant association between APA positivity and hypopituitarism due to TBI (odds ratio: 2.25, 95% confidence intervals 1.1–4.6). Moreover, there was a significant positive correlation (r=0.74, P=0.004) between APA titer ratio and peak GH response to GHRH+GH related peptide (GHRP)-6 test, suggesting that high APA titers were associated with low GH response to GHRH+GHRP-6 test.ConclusionsThis study shows for the first time the presence of the APA in TBI patients 3 years after head trauma. Moreover, present investigation indicates preliminary evidence that APA may be associated with the development of TBI-induced pituitary dysfunction, thus suggesting that autoimmunity may contribute in the development of TBI-induced hypopituitarism. The presence of the association between APA and TBI-induced hypopituitarism may provide a new point of view in this field and promote further clinical and experimental studies.

scholarly journals The Prevalence of Pituitary Dysfunction in Children Following Severe Traumatic Brain Injury in the Acute Phase

2020 ◽  
pp. 89-94
Author(s):  
Adil Rabi ◽  
Abdelali Tali ◽  
Said Younous ◽  
Laila Chabaa
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Trauma ◽  
Acute Phase ◽  
Severe Traumatic Brain Injury ◽  
Clinical Signs ◽  
University Hospital ◽  
Endocrine Disorders ◽  
Pituitary Dysfunction ◽  
Cortisol Levels

Neuro-endocrine disorders are a frequent complication of head trauma. The exploration of these disturbances is important because it can contribute to the understanding of some symptoms presented by the patients for better management in the acute phase or during the evolution. Aim: The objective of this study was to identify the anterior pituitary dysfunction of severe traumatic brain injury and to analyze the correlations between these disorders, brain lesions and clinical signs. Materials and Methods: This is a prospective and descriptive study, conducted in collaboration between the pediatric intensive care unit and the clinical biochemistry laboratory of the Mohammed VI University Hospital of Marrakech. This study was spread over 9 months. It Included children admitted for severe head trauma and with a clinical, hormonal and CT scan. And the interest was in 28 severely traumatized skulls in the acute phase. All patients received TSH, T3, T4, Prolactin and cortisol levels 8 hours after admission. Results: There were twenty eight patients included in the study. Sex ratio m / f of 1.54, whose age varies between 9 months and 14 years, with an average age of 6.5 years. Half of the patients had an initial Glasgow score of 8/15. This was cerebral oedema in (46.42%) cases. In this study, the rate of endocrine disorders was 85.71%, the exploration of the thyrotropic axis proved normal in all of these patients. Low cortisol levels were observed in 11% of cases, 67.84% of children had hyperprolactinemia. One-third of the patient included in the study had 2-axis involvement, namely cortisol and prolactin. Half, on the other hand, showed only one axis. Conclusion: In the aftermath of head trauma, pituitary disturbances are frequent and should be included in their management.

MRI in 30 cats with traumatic brain injury

2018 ◽  
Vol 21 (12) ◽  
pp. 1111-1119 ◽  
Author(s):  
Abby Caine ◽  
Robert Brash ◽  
Luisa De Risio ◽  
Jan Van Dijk ◽  
Giunio Bruto Cherubini ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Tissue Injury ◽  
Brain Mri ◽  
Soft Tissue Injury ◽  
Clinical Signs ◽  
Case Series ◽  
Magnetic Resonance Images ◽  
Neurological Deficits ◽  
Imaging Features

Objectives The aim of this study was to evaluate the MRI findings in cats following traumatic brain injury (TBI), and establish which features identified might correlate with prognosis. Methods The magnetic resonance images of 30 cats with clinical signs attributed to the brain following TBI were retrospectively reviewed to assess the imaging features seen and their correlation with outcome. Results Twenty-one of 30 cats had a good outcome (full recovery or minor ongoing neurological deficits); the other nine either died or had ongoing neurological deficits that significantly affected quality of life. There was evidence of parenchymal injury in only 20/30 cats, including 8/9 that had a poor outcome. The frequency of bilateral or multifocal parenchymal lesions on T2-weighted imaging, and mass effect, particularly caudal transtentorial herniation, was statistically significantly higher in patients with a poorer outcome. Extra-axial haemorrhage was not identified. Concurrent soft tissue injury was noted in all cats, with a poorer prognosis statistically associated with a peripharyngeal pattern of injury and orbital trauma. Conclusions and relevance The number of cases with MRI-identified brain pathology, the patterns of injuries identified and the specific imaging features that appear to have effects on prognosis differ in this series of cats from those published in similar case series of dogs. Further work is needed to establish if cat-specific guidelines are needed to assess brain MRI following trauma.

Diagnostic value of S100B and neuron-specific enolase in mild pediatric traumatic brain injury

2009 ◽  
Vol 4 (4) ◽  
pp. 339-344 ◽  
Author(s):  
Christian Geyer ◽  
Anett Ulrich ◽  
Gerd Gräfe ◽  
Barbara Stach ◽  
Holger Till
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Trauma ◽  
Clinical Signs ◽  
Neuron Specific Enolase ◽  
Minor Head Trauma ◽  
Mild Tbi ◽  
Asymptomatic Children ◽  
Significant Difference ◽  
Gcs Score

Object During recent years, several biomarkers have been introduced for use in the diagnosis of traumatic brain injury (TBI). The primary objective of this investigation was to determine if S100B (or S100 calcium-binding protein B) and neuron-specific enolase (NSE) serum concentrations can effectively be used to discriminate between symptomatic and asymptomatic children with minor head trauma. Methods The authors conducted a prospective clinical study that involved patients age 6 months to 15 years who had sustained minor head trauma. Children with concomitant extracranial injuries were excluded. Blood samples were obtained within 6 hours of injury to measure S100B and NSE levels in serum. The authors defined 2 diagnostic groups: a mild TBI group (patients with Glasgow Coma Scale [GCS] scores of 13–15) in whom there were clinical signs of concussion (short loss of consciousness, amnesia, nausea, vomiting, somnolence, headache, dizziness, or impaired vision) and a head contusion group (patients with a GCS score of 15) in whom symptoms were absent. Both S100B and NSE concentrations were compared between the 2 groups. Secondary end points were defined as follows: correlation of S100B/NSE and a) the presence of scalp lacerations, b) GCS score, c) age, and d) correlation between S100B and NSE. Results One hundred forty-eight patients were enrolled (53 in the contusion group, 95 in the mild TBI group). After adjusting for differences in age and time of injury to blood sample withdrawal, there was no significant difference in S100B or NSE between patients in the 2 groups. Scalp lacerations and GCS score had no affect on posttraumatic S100B or NSE concentrations. The correlation between S100B and NSE was significant. Both markers showed a significant negative correlation with age. Conclusions The authors demonstrated that S100B and NSE do not discriminate between symptomatic and asymptomatic children with minor head injury. There seem to be limitations in marker sensitivity when investigating pediatric patients with mild TBI.

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